Organization
GREEN LINE EXPRESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINA PROCACCIANTI PHARMD (FACILITY ADMINISTRATOR)
(401) 360-3200
Entity
Organization
Contact information
Practice address
245 MAIN ST, WAKEFIELD, RI 02879-3527
(401) 360-3500
Mailing address
245 MAIN ST, WAKEFIELD, RI 02879-3527
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01645
AMBULATORY CARE FACILITY LICENSE
RI
Enumeration date
09/10/2021
Last updated
09/10/2021
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